PB2024: CLUSTERING OF COMORBIDITIES IS RELATED TO AGE AND SEX AND IMPACTS CLINICA1 OUTCOME IN MYELODYSPLASTIC SYNDROMES: RETROSPECTIVE COHORT STUDY
Authors: Talbi Faiza, Otsmane Hakim, Abbadi Rafik, Belakehal Salah, Bachiri Aissa
Journal: HemaSphere (2023)

Topic: 10. Myelodysplastic syndromes - Clinical Background: MDS 1 are commonly classified according to French–American–British (FAB). 1 Risk scoring in MDS is so far based 1 on evaluation of parameters representing the biology of the disease like blast counts, cytogenetics, or cytopenias. However, patient-associated parameters 1 like age or performance status have been 1 established as prognostic parameters in MDS. Moreover, while the impact of distinct comorbidities or possible cumulative effects on the survival of patients with MDS have been described by several groups, 1 the implications were discussed controversially as different scoring systems, namely the Charlson Comorbidity Index (CCI), 1 hematopoietic cell transplantation-comorbidity index (HCT-CI), Adult Comorbidity Evaluation-271 (ACE-27) and MDS-Specific Comorbidity Index (MDS-CI), were applied and multivariate analyses incorporating the IPSS were not included in all studies. Moreover, the distribution of comorbidities among distinct age and sex groups has been analyzed by Christoph Bammer in a in a recent study published (March 11, 2014). The following parameters recorded in the data set were considered in the analysis: age, sex, FAB subtype, IPSS and HCT-CI scores. Comorbidities were classified retrospectively by means of the HCT-CI score as described by Sperr et al. The HCT-CI scoring system consists of a list of 17 groups of diseases with 1 assigned weight. The score assigns 1 point to arrhythmia, cardiovascular, inflammatory bowel, cerebrovascular, psychiatric and mild hepatic disease as well as diabetes, obesity or infection; 1 2 points to rheumatologic, renal 1 and moderate pulmonary disease or peptic ulcer; 3 points to severe pulmonary, moderate to severe hepatic and valvular heart disease as well as prior solid tumor. The score results in a classification as low (0 points), intermediate (1 to 2 points), and high (≥3 points) risk Aims: The clinical outcome of a well-characterized cohort of patients with MDS was analyzed for prevalence and impact of comorbidities. Focus was on age- and sex-related differences Methods: The hematopoietic cell transplantation-comorbidity index (HCT-CI) was assessed in 84 patients with MDS and monitored at the central hospital of the army (Algeria), the median age was 64 years (20-92 years) Results: The patient cohort consisted of 84 individuals including. The overall 40: 47% patients (12 patients: 30% females, and 28: 70 % males: f/m=4, 2), displayed one (13/40 patients: 32%) or more (68%) comorbidities. Median age was 68 (range: 22–89) years; the median age of female patients was 65 (range: 48–80) years; the median age of male patients was 70 (range: 25–91) years. Our patients were classified according to FAB criteria: refractory anemia (RA: 25%), refractory anemia with ring sideroblasts (RARS: 15%), refractory anemia with excess of blasts (RAEB: 17%), RAEB in transformation (RAEB-T: 15%). The highest frequencies were observed for cardiovascular disease (40%), diabetes (30%), and pulmonary disease (29%).Comorbidities were not more frequent (HR= 1, 65, 95% CI= 0, 65- 3, 66) in men than in women, but more severe (≥3 points: 11 patients) risk in male (8 cases: 75%: HR: 4: CI 95%: 1, 06-4) P = 0,02. Elderly patients (65+ years) showed a higher prevalence of comorbidities than younger patients: HCT-CI score: HR= 0, 18 (IC 95%: 0, 04-0, 83) in 65+: P= 0,014. High risk was significantly associated with shorter overall survival (p = 0.001). Summary/Conclusion: Comorbidities impact clinical and survival outcome in elderly patients with MDS, which may have clinical implications when designing individualized therapies. Comorbidities should be evaluated with established scores and integrated in decision making.Keywords: Comorbidities, Cerebrovascular disease, Myelodysplastic syndrome, Age related clonal hematopoiesis